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Dear Authors,
Thank you for addressing the reviewers' comments.
Best regards.
All my comments and suggestions were properly addressed and I agree with the responses and paragraphs added to the manuscript.
All my comments and suggestions were properly addressed and I agree with the responses and paragraphs added to the manuscript.
All my comments and suggestions were properly addressed and I agree with the responses and paragraphs added to the manuscript.
All my comments and suggestions were properly addressed and I agree with the responses and paragraphs added to the manuscript. I suggest the editors accept the article for publication.
Dear authors,
Please revise the manuscript considering the reviewers´ comments.
Thank you.
Best regards.
This article by Li et al. aims to determine the potential of nonstationary cardiorespiratory coupling analysis alongside traditional HRV in evaluating the therapeutic effect of breathing training on autonomic nervous function. Considering the basic reporting standards, this study is written in clear English and considers correct technical language in accordance with the proposed line of research. It also contains sufficient bibliography to support the introduction and discussion of the study.
The research is primary research within the Aims and Scope of the journal, however, it is not possible to derive a rationale, an objective that responds to the rationale for carrying out this research, and an hypothesis to be tested with the experiments and analysis carried out. It is a research that responds to ethical statements, but regarding to the methodology I have several considerations.
1. The methodology does not indicate how the sample size was achieved to begin considering an n of 39 patients.
2. Although some clinical parameters of the patients evaluated in table 1 are indicated, these are quite irrelevant to the reported pathological conditions of the subjects, they only indicate that they have ventilatory alterations, but there is no ventilatory parameter that indicates that they have ventilatory alterations, nor are there any reported cardiovascular parameters such as heart rate, systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial blood pressure, heart rate, oxygen saturation, peak expiratory flow, peak inspiratory flow, expiratory reserve volume, vital capacity or respiratory frequency.
3. There is no control group to make comparisons considering that only patients with cardiovascular or respiratory pathologies were analyzed.
4. They do not indicate whether the group of patients evaluated actually has an underlying autonomic imbalance that needs to be modulated with respiratory training.
5. As a reviewer, I am unable to determine what the hypothesis of the study is and what the real objective of the study is, considering that in no section of the introduction is the rationale for studying cardiorespiratory coupling indicated as a tool to determine the autonomic activity of subjects undergoing respiratory training.
6. There is no section on statistical analysis, and it is not possible to determine what statistical tests were used for the comparative analyses, nor the tests to determine data normality.
7. There is no section that indicates the limitations of the study or how novel this analysis may be.
- Impact and novelty not assessed.
- By not describing the statistics of the data analyzed, statistical tests of normality and comparison in the methodology section of the study, the robustness of these results cannot be determined.
- Because there is no clear rationale for the study, clear objective and explicit hypothesis, it is difficult to conclude that, according to the reported data, CRC analysis is a valid tool for determining autonomic activity in patients with respiratory disorders who undergo respiratory training.
Li and colleagues present evidence from a breathing training intervention in N = 39 respiratory patients with simultaneous ECG recordings. The authors make a compelling case for the benefits of analysing cardiorespiratory coupling in addition to more conventional analyses of HRV when evaluating ANS function. While the question is certainly of interest for the field, both the clinical procedure and the conducted analyses have to be described in greater detail in order for the reader to meaningfully evaluate them. I believe this necessary level of detail is easy to provide for the authors and I look forward to receiving the revised manuscript.
Signed: Daniel S. Kluger
Major:
While the description of data preprocessing was very clear, the same can unfortunately not be said about the breathing training itself. The section ‘Subjects and Experiments’ should be revised to make the ‘training prescriptions’ and ‘audial and visual interactive breathing guiding patterns’ fully transparent. How long did one training session last? Were there multiple sessions? What did the patients actually do during the training? I regret to say that with the current description of the training routine, it is close to impossible for the reader to evaluate pre-post comparisons.
In the HRV analysis, no statistical results are presented in the main text. Please state the tests and the corresponding results clearly, significant or not.
What was the motivation for the HRV subgroup analysis? From the text, it seems like the non-significance of the HRV analysis prompted the authors to look at subgroups (in which case correlations with a continuous measure would be more sensitive). Please elaborate.
It remains equally unclear based on which criterion/criteria patients were divided into subgroups. This is a critical point, since discretising a population based on an originally continuous criterion comes with many negative implications from a statistical standpoint. It seems like the authors report qualitative results within the Methods section (starting in l. 148), but it is not stated whether these ‘subtypes’ were quantified or statistically compared in any way.
Extending my comment above, none of the Results subsections make sufficient mention of which tests were conducted and what the precise results were. Please revise your statistical reporting accordingly.
Minor:
As a fellow non-native English speaker, I felt that the authors’ language could be improved in certain places to make their arguments more accessible and increase clarity. One of those instances was the Introduction section where the two methods for quantifying HRV are described in a single sentence running over seven lines (ll. 50-56). Statements like ‘many efforts have been focused on the pursuit of RSA (l. 67) should be revised to more clearly express the authors’ key message.
The figure legends were at times rather uninformative and should be revised, particularly Fig. 1, Fig. 3, and Fig. 5.
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